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December 2021

Get ready for welcome to Medicare and annual wellness visits for Medicare Plus Blue patients

The new year will bring new and existing Medicare Plus Blue℠ members to your medical practice for their annual wellness visits. These visits are at no cost to members and play an important role in helping maintain or improve their health.

Welcome to Medicare visit

New Medicare Plus Blue members should be scheduling their welcome to Medicare preventive visit, which is their Initial Preventive Physical Examination. This is a one-time appointment for new Medicare patients to be scheduled within their first 12 months of enrollment. Medicare pays for one welcome to Medicare visit per member, per lifetime.

This visit is a great way to get up-to-date information on health screenings, shot records, family medical history and other preventive care services. For more information on the components of a welcome to Medicare visit, see the Medicare Learning Network Educational Tool.**

The following is the billing code for the welcome to Medicare visit, also known as the Initial Preventive Physical Examination, or IPPE:

  • G0402

Annual wellness visits

Existing Medicare Plus Blue℠ members should be scheduling their annual wellness visits. Medicare will cover an annual wellness visit every 12 months for patients who’ve been enrolled in Medicare for longer than 12 months.

The annual wellness visit is a chance for you to develop or update your patient’s personalized prevention plan based on his or her current health situation and risk factors. A health risk assessment is part of the annual wellness visit. It includes self-reported information from your patient to be completed before or during the visit. For more information on the components of an annual wellness visit, see the Medicare Learning Network Educational Tool.**

The following are billing codes for annual wellness visits, which include a personalized prevention plan of service:

  • G0438 — First visit AWV; can only be billed one time, 12 months after a G0402 (IPPE)
  • G0439 — Annual wellness visit (subsequent)

Note: G0438 or G0439 must not be billed within 12 months or previous billing of a G0402 (IPPE).
You can also offer to conduct virtual visits depending on your office’s capabilities.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.